Consent to receive massage
It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis.
I have completed this form to the best of my ability and knowledge and agree to inform my therapist if any of the above information changes at any time.
I understand that my personal health information will be collected. I understand that all information that I provide will be kept confidential unless required by law. I understand and consent that my medical information may be shared by the various care providers involved in my care and treatment.
I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.
By signing my consent I agree to the client privacy policy and SMS messaging policy as follows; Solange Connolly, LMT [the business] will collect my phone number and any information I provide through SMS messaging. My phone number and messages are used solely for communication purposes, including appointment scheduling, reminders, and important notifications. The business does not share my phone number or messages with third parties, except as required by law. The business employs reasonable security measures to protect my information from unauthorized access, use, or disclosure. By communicating with the business via SMS, I consent to the collection and use of my information as outlined in this policy and messages and data rates may apply. Message frequency will vary. I can opt-out of SMS communications at any time by replying "STOP" to the messages. If I have any questions or concerns about this privacy policy, please contact the business at solangemconnolly@gmail.com
I have read and agree to the terms above (please sign your full name):
Policy Notification
I appreciate that you’ve chosen me for your massage and bodywork needs. To provide the best service possible to my clients I have implemented the following policies.
Cancellation Policy
I respectfully ask that you provide me with a 24 hour notice of any schedule changes or cancellation requests. Please understand that when you cancel or miss your appointment without providing a 24 hour notice I am often unable to fill that appointment time. This is an inconvenience to me and also means my other clients miss the chance to receive services they need. For this reason, you will be charged 100% of the service fee.
I also reserve the right to require a credit card number to be given to book future appointments so that appropriate fees may be charged if a late cancellation does occur.
I understand that emergencies can arise and illnesses do occur at inopportune times. If you have a fever, a known infection, or have experienced vomiting or diarrhea within 24 hours prior to your appointment time, I request that you cancel your session. Inclement weather may also result in the need for late cancellations. I will do my best to give advanced notice if I am closing or need to cancel due to bad weather and I ask you to do the same. Please do not risk your own safety trying to make your appointment. Late cancellation due to emergency, illness, or inclement weather will generally not result in any missed session charges, but this is determined on a case-by-case basis.
Late Arrival Policy
I request that you arrive 5-10 minutes prior to your appointment time to allow time to fill out any required paperwork as well as answer any intake questions that I may have. I understand that issues can arise that may cause you to be late for your appointment. However, I ask that you call to inform me if this ever occurs so I can do my best to accommodate you. Appointment times are reserved for each client, so oftentimes I cannot exceed that reserved time without making the next client late. For this reason, arriving after your appointment time may result in loss of time from your massage so that your session ends at the scheduled time. Full service fees will be charged even when sessions are shortened due to late arrival. In return I will do my best to be on time, and if I am unable to do so I will add time to your session to make up for our late arrival or adjust the service charge accordingly.
Inappropriate Behavior/Sexual Harassment Policy
Massage therapy is for relaxation and therapeutic purposes only. There is absolutely no sexual component to massage whatsoever. Any insinuation, joke, gesture, conversation, or request otherwise will result in immediate termination of your session and a refusal of any and all services in the future. You will be charged the full service fee regardless of the length of your session. Depending on the behavior exhibited I may also file a report with the local authorities if necessary. Treat me with respect and dignity and you will be treated the same in return.
I have read and agree to the terms above (please sign your full name):
